BOOK REVIEW
Recollections of Death: A Medical Perspective
by Michael B. Sabom - Harper and Row, $13.50
Michael Grosso
Department of Philosophy
Jersey City State College
Empirical studies of near-death phenomena have been published
from the viewpoint of several disciplines: philosophy (Moody, 1975);
parapsychology
(Osis and Haraldsson, 1977); transpersonal psycho
logy (Ring, 1980); and psychiatry (Greyson and Stevenson, 1980;
Noyes, 1979). In this book, Michael Sabom, a cardiologist and
professor of medicine at Emory University in Georgia, brings an
almost exclusively medical perspective to bear on the study of near
death experiences. Although another cardiologist, Maurice Rawlings,
has previously published on this subject (Rawlings, 1978), his book,
while not without interest, is more of a sermon than a scientific
document.
In contrast, Recollections of Death is a sober and objective inves
tigation of near-death phenomena. While readable for the layperson,
the thrust of the book is toward arousing the medical community
from its dogmatic slumbers. Sabom urges that "caution should be
exercised in accepting scientific belief as scientific data".
Sabom himself was roused to question his scientific dogmas by
Moody's Life After Life and, with Sarah Kreutziger, a psychiatric
social worker, set out to investigate Moody's claims. 116 persons
formed the basis of the study; 10 of these encountered their crisis
event in conjunction with general anesthesia during surgery. Of the
remaining 106 cases, 78 were obtained prospectively; 43 percent of
these reported a near-death experience (NDE). Sabom concludes
from this that NDEs are a "common" event among those who survive
near-death incidents. On the whole, Sabom's findings are consonant
with those of previous researchers.
173
Anabiosis-The Journal for Near-Death Studies
The author distinguishes three types of NDE. The first he calls
"autoscopic." Here the subject, during a near-death situation, finds
himself "out-of-body," a detached observer of his physical organism,
usually from a position suspended near the ceiling. A second type of
NDE is called "transcendental." Here the person ostensibly enters an
environment that "transcends" the observable physical environment.
In the third type of NDE, the person experiences both autoscopic and
transcendental elements during the NDE, the latter usually unfolding
in sequence from the former. Sabom's basic distinction is useful on
the grounds that the autoscopic component of the experience can be
whereas the transcendental apparently cannot.
There might be an exception in some rare cases of "meeting"
others not known by the near-death experiencer to be dead. These
cases were called by William Barrett (1926) "peak-in-Darien." Also,
the transcendental component may contain, as reported by Ring,
"flashforward" or precognitive elements. In any case, Sabom's work
does not focus on these possibilities. Another question that needs to
be addressed is why the transcendental generally follow the autoscopic
episodes. Prima facie, at least, if an aspect of a person were really
"splitting off" from a dying body and embarking on a "journey
beyond," this would seem to be the most plausible sequence - i.e.,
from autoscopic to transcendental.
The most original contribution of this book lies in Chapter Seven,
where the author provides some detailed corroborations of the objec
tive nature of the autoscopic component of the NDE. There are, in
fact, at least two distinct kinds of questions we can ask about the NDE.
One is phenomenological, the other ontological. At the level of phe
nomenology, the NDE is "real" - i.e., it is what it appears to be.
Moreover, it is meaningful in a variety of ways: for the experiencer;
for the physician (it may have therapeutic significance); for the
student of comparative religion (it may resemble classic conversion
experiences); and so forth. But beyond questions of phenomenology
are questions of ontology - i.e., is the NDE "really" real, occurrent
independently of the subject's mind and brain states? My impression
is that even among serious researchers of NDEs, there is a tendency
to shy away from the ontological question. This may in part be due
to a feeling that the phenomenological dimension of the experience
is of sufficient importance. On the other hand, one might be reluc
tant to ascertain that one's favorite research baby is just a fascinating
verified,
illusion.
The virtue of Sabom's book is that it broaches the ontological
question, at least in regard to the autoscopic component of the
NDE. Thirty-two of Sabom's patients claimed to be out of their
Book Review
174
bodies and able to provide visual accounts of cardiopulmonary
resuscitation procedures being performed upon their bodies during
periods of apparent unconsciousness or clinical death.
In order to evaluate these reports, Sabom tested the hypothesis
that cardiac patients could provide a pseudo-veridical account of
CPR procedures on the basis of an "educated guess." He inter
viewed 25 "control" patients with medical backgrounds similar
to those who had autoscopic episodes and found that 23 of them
made at least one major error in their descriptions of the CPR
procedures. In contrast to the control group, none of the autoscopic
patients made any serious errors in their descriptions. Twenty-six of
the thirty-two autoscopic subjects had only general, nonverifiable
details in their accounts. According to these patients, this paucity of
detail was due to their being absorbed in "overall amazement at what
was occurring".
Six, however, of the thirty-two provided specific, verifiable details
in their NDE reports. Indeed, particularly valuable are the ample and
detailed accounts of the NDEs, especially of the autoscopic episodes.
Sabom's procedure was to compare the patient's medical report with
his own near-death account. He obtained further verification, when
ever possible, from relatives who may have witnessed the near-death
event. Finally, Sabom's own medical expertise is crucial in the evalu
ation of these autoscopic episodes. The six cases cited are impressive.
Sabom makes a strong case for the veridical nature of the near-death
out-of-body experience. In short, we have here for the first time
expert medical testimony that patients who apparently are either un
conscious or who have lost all vital signs are in reality conscious and
capable of accurate observations of the physical environment from a
viewpoint spatially separate from their bodily organisms. This rather
astonishing fact simply does not fit into the current, orthodox bio
medical model.
No less intriguing is the next chapter in which several cases are
cited of persons who "learned," after initial NDEs, to have out-of
body experiences. The evidence presented for these extended
ecsomatic capacities is largely anecdotal. Nevertheless, they force us
to ask an interesting question. In Sabom's words: "Could some latent
human ability have been activated by the near-death crisis event,
allowing these autoscopic experiences to repeat themselves under
non-near-death circumstances?" This question gives rise to another:
in addition to the near-death crisis, are there other circumstances,
"mechanisms," or "triggers" that may, perhaps in a fragmentary
way, activate a latent human ability, an ability to function indepen
dently of the ordinary limits of bodily existence? And, if so, what is
17 5
Anabiosis-The Journal for Near-Death Studies
the fundamental "mechanism," or complex of "mechanisms," in
volved in NDE, out-of-body, and related phenomena of transcen
dence? In my opinion, future research needs to address these ques
tions and to attempt to grasp the NDE in relation to this possibly
wider set of psychophysical interactions.
Altogether, Sabom critically examines a dozen possible ways to
account for the NDE: as the result of semiconscious states, conscious
fabrication, unconscious fabrication, depersonalization, autoscopic
hallucinations, dreams, prior expectations, drug-induced delusions or
hallucinations, endorphin release, temporal lobe seizures, hypoxia,
and hypercarbia. None of these explanations, according to Sabom,
quite fit the phenomena they are supposed to account for. Sabom
could have made his case more effectively, if he had stated more
clearly what it is about the NDE that calls for explanation. His
approach is more ad hoc - e.g., he rejects the psychodynamic
explanation of NDEs as subconscious fabrications to ward off the
fear of extinction. Sabom's reason for rejecting this explanation is
that, if true, it works much too inconsistently. For instance, in
multiple near-death situations, the near-death (allegedly defensive)
experience occurs only once, or it manifests during the least life
threatening situation. But this is not an entirely effective rebuttal,
for there is no reason to believe that our psychological defense sys
tems work with infallible efficiency. No doubt it would be desirable
if they did, but the subconscious mind is not a computer. And even
our best computers have their off-days.
In general, Sabom's strategy is to show that the NDE represents a
unique complex of phenomena for which none of the explanations
adequately accounts. For instance, endorphins are pain-killing sub
stances released by the brain during periods of stress. The action of
endorphins, however, produces effects that last from 22 to 73 hours;
freedom from pain in the NDE lasts only the duration of the experi
ence - seconds or minutes. Further, endorphins produce sleep and
somnolence, not the clarity and intensity of vision associated with
the NDE.
Of special interest is the discussion of hypercarbia - increased
levels of carbon dioxide in the brain. Experiments with elevated
levels of C02 are cited in which experiences were produced closely
akin to NDEs: light and out-of-body effects, panoramic memories,
ineffability, religious presences, and so forth. As Sabom rightly ob
serves, however, we do not know if the C02 surplus is the sole cause
of the NDE or simply a physiological correlate of the NDE. To com
plicate matters, in the one case in which the patient's carbon dioxide
blood oxygen levels were measured at the very moment of his
,nd
Book Review
176
NDE, the oxygen level was above normal (thus ruling out hypoxia)
and the carbon dioxide level was below normal (thus ruling out
hypercarbia). In any case, hypercarbia. intoxication constitutes a
possibly valuable line of research into NDEs, for it is a method, free
of serious risk, of mimicking, fairly closely it would seem, full-blown
near-death experiences.
Sabom is very cautious in his conclusions about the ultimate sig
nificance of the phenomena he has studied. He does apparently in
cline
toward a dualistic interpretation of near-death phenomena,
however,
citing
for support
the
philosophical
speculations
of
neurologists Penfield and Sherrington. The most I am willing to say
in this brief review is that much of the material in Sabom's book
makes the case for anti-dualists considerably more difficult than
otherwise.
A separate list of references would have been handy, especially for
those not initiated into the medical literature on the subject. On the
other hand, there are few, if any, references to the large and relevant
parapsychological literature on NDEs and related phenomena. This is
unfortunate, since, if - as I hope it will - Sabom's book reaches a
medical readership, an opportunity will have been lost to shake them
even further from their dogmatic slumbers. For after all, near-death
research is only a part of a large mass of explorations into the hinter
lands of human potential.
REFERENCES
Barrett, W. Death-Bed Visions. London: Methuen, 1926.
Greyson, B., and Stevenson, I. The phenomenology of near-death
American Journal of Psychiatry, 1980, 137,
experiences.
1193-1196.
Moody, R. Life After Life. Atlanta: Mockingbird Press, 1975.
Noyes, R. Near-death experiences:
cance. In R. Kastenbaum (Ed.)
their interpretation and signifi
Between Life and Death. New
York: Springer, 1979.
Osis, K., and Haraldsson, E. At the Hour of Death. New York: Avon,
1977.
Rawlings, M. Beyond Death's Door. Nashville: Thomas Nelson, 1978.
Ring, K. Life at Death. New York: Coward, McCann and Geoghegan,
1980.